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Nursing 105 > Assessment of Cardiac Function- Exam 1 > Flashcards

Assessment of Cardiac Function- Exam 1 Flashcards

1
Q

3 layers of the heart muscle

A

Endocardium, myocardium, epicardium

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2
Q

4 chambers of the heart

A

R atrium and ventricle, L atrium and ventricle

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3
Q

2 atrioventricular valves

A

tricuspid and mitral

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4
Q

2 semilunar valves

A

aortic and pulmonic

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5
Q

What is the primary pacemaker for the myocardium?

A

sinoatrial node

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6
Q

What is the secondary pacemaker of the heart?

A

atrioventricular node

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7
Q

What kind of cells are the SA and AV node made of?

A

nodal cells

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8
Q

Electrical activation of cell caused by influx of sodium and potassium exits cell

A

depolarization

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9
Q

Return of cell to resting state caused by reentry of K+ into cell while NA+ exits

A

Repolarization

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10
Q

2 types of refractory periods

A

effective/absolute refractory period
relative refractory period

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11
Q

3 parts of a Cardiac Action Potential

A

Depolarization
Repolarization
Refractory Periods

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12
Q

Type of refractory period that describes the phase in which cells are incapable of depolarizing

A

effective/absolute refractory period

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13
Q

Type of refractory period describing the phase in which cells require stronger-than-normal stimulus to depolarize

A

Relative refractory period

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14
Q

Phase 1 of the Cardiac Action Potential Cycle

A

Rapid repolarization

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15
Q

Phase 0 of the Cardiac Action Potential Cycle

A

Rapid depolarization

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16
Q

Phase 3 of the Cardiac Action Potential Cycle

A

Final repolarization

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17
Q

Phase 4 of the Cardiac Action Potential Cycle

A

Resting

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18
Q

Refers to the events that occur in the heart from the beginning of one heartbeat to the next

A

cardiac cycle

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19
Q

The number of cardiac cycles depends on what?

A

heart rate

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20
Q

Each cardiac cycle has what 3 major sequential events?

A

Diastole
Atrial systole
Ventricular systole

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21
Q

Percent of end diastolic volume ejected with each heart beat (L ventricle)

A

ejection fraction

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22
Q

The ejection fraction refers to what chamber of the heart?

A

left ventricle

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23
Q

The amount of blood pumped by ventricle in L/min

A

cardiac output

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24
Q

Equation for Cardiac Output

A

CO = SV x HR

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25
The amount of blood ejected with each heartbeat
Stroke volume
26
The degree of stretch of cardiac muscle fibers at end of diastole
Preload
27
The resistance to ejection of blood from ventricle
Aferload
28
The ability of cardiac muscle to shorten in response to electrical impulse
Contractility
29
3 parts of stroke volume
Preload Afterload Contractility
30
What are the influencing factors of cardiac output?
Control of heart rate Control of stroke volume
31
What systems control heart rate?
Autonomic nervous system Baroreceptors
32
The Frank-Starling Law refers to controlling what part of the stroke volume?
Preload
33
What specifically affects the control of the afterload?
Affected by systemic vascular resistance, pulmonary vascular resistance
34
Contractility is increased by what?
Catecholamines, SNS, and certain medications
35
Increased contractility results in increased ?
stroke volume
36
Decreased contractility is caused by ?
Hypoxemia, acidosis, and certain medications
37
Which of the following best defines stroke volume? a. the amount blood ejected with each heartbeat b. amount of blood pumped by the ventricle in liters per min c. degree of stretch of the cardiac muscle fibers at the end of diastole d. ability of the cardiac muscle to shorten in response to an electrical impulse
a. the amount of blood ejected with each heartbeat
38
What information do you want to collect as the nurse assessing the cardiovascular system?
-health hx, demos, family/genetic hx, cultural/social factors, risk factors
39
2 types of risk factors in cardiac health
modifiable nonmodifiable
40
Common symptoms associated with cardiac health
Chest pain/discomfort Pain/discomfort in other areas of the body SOB/dyspnea Peripheral edema Weight gain Abdominal distention Palpitations Unusual fatigue Dizziness Syncope Change in LOC
41
What is assessed during the physical assessment portion of the cardiac assessment? (how many times can you say assess in one sentence?)
General appearance Skin/extremities Pulses BP and orthostatic changes Jugular vein pulses Heart inspection, palpation, auscultation
42
Lab tests for cardiac events/health
Cardiac biomarkers Blood chemistry, hematology, coagulation Lipid profile BNP CRP Homocysteine
43
Describe how to perform a physical cardiac stress test
-Pt walks on treadmill with intensity progressing -Monitor ECG, V/S, symptoms -Test ends when target HR is achieved
44
How is a pharmacologic stress test performed?
Vasodilating agents are given to mimic exercise
45
Diagnostic Radionuclide Imaging Tests
Myocardial perfusion imaging Positron emission tomography Ventricular function tests CT MRA
46
Noninvasive ultrasound test that is used to measure the ejection fraction and examine the size, shape, and motion of cardiac structures
echocardiography
47
What does an echocardiogram measure?
the ejection fraction, size, shape, and motion of cardiac structures
48
2 types of echocardiographys
Transthoracic Transesophageal
49
An invasive procedure used to diagnose structural and functional diseases of the heart and great vessels
Cardiac catheterization
50
Type of catheterization that uses pulmonary artery pressure and O2 sats and a possible biopsy of myocardial tissue
Right heart catheterization
51
Type of catheterization that involves use of contrast agent
Left heart catheterization
52
Nursing interventions for cardiac events
Observe cath site bleeding, hematoma Assess pulses Eval temp, color, cap refill Screen for arrhythmias Maintain bed rest of 2-6 hrs Instruct pt to report chest pain, bleeding Monitor for contrast-induced nephropathy Ensure pt safety
53
What does hemodynamic monitoring measure?
Central venous pressure Pulmonary artery pressure Intra-arterial BP monitoring Minimally invasive CO monitoring
54
Central venous pressure is a measurement of the pressure in which area of the heart?
Vena cava or right atrium
55
The pressure in the vena cava, right atrium, and right ventricle is equal at the end of?
Diastole
56
Central venous pressure also reflects filling pressure of?
The right ventricle (preload)
57
What is the normal central venous pressure range?
2-6 mm Hg
58
Decreased blood flow and oxygen to the heart muscle
Ischemia
59
Tissue is deprived of oxygen and nutrients causing death of tissue
Infarction
60
The abnormal accumulation of lipid deposits and fibrous tissue within arterial walls and lumen
Atherosclerosis
61
What is the most prevalent cardiovascular disease in adults?
CAD
62
Clinical manifestations of atherosclerosis are caused by what specifically?
myocardial ischemia
63
Symptoms and complications of atherosclerosis are related to what?
The location and degree of vessel obstruction
64
What is the most common manifestation of atherosclerosis?
Angina pectoris
65
What causes angina?
hypoxia
66
Clinical manifestations of atherosclerosis
Angina Epigastric distress Pain radiating to jaw or left arm SOB Atypical symptoms in women MI HF Sudden cardiac death
67
4 Modifiable Risk Factors for CAD
Cholesterol abnormalities Tobacco use HTN Diabetes
68
All risk factors for CAD
Cholesterol abnormalities Tobacco use HTN Diabetes Elevated LDL Metabolic syndrome hS-CRP elevation
69
How can CAD be prevented?
Control cholesterol Dietary measures Physical activity Medications Cessation of tobacco use Manage HTN Control diabetes
70
6 types of lipid-lowering agents
Statins Nicotinic acids Fibric acids Bile acid sequestrants Cholesterol absorption inhibitors Omega-3 acids
71
The nurse is caring for a patient with hypercholesterolemia who has been prescribed atorvastatin. What serum levels should be monitored in this patient?
Liver enzymes
72
A syndrome characterized by episodes or paroxysmal pain or pressure in the anterior chest caused by insufficient coronary blood flow
Angina pectoris
73
How might a patient describe angina pain?
Tightness, choking, or a heavy sensation
74
What frequently accompanies the pain of angina?
Anxiety
75
Where might anginal pain radiate to?
Neck, jaw, shoulders, back or arms
76
What other symptoms, aside from pain, may be seen with angina?
Dyspnea SOB Dizziness Nausea Vomiting
77
If a patient's chest pain is alleviated with rest, what kind of angina is this?
stable angina
78
If a patient's chest pain is increased in frequency and is not relieved by rest and nitroglycerin, what kind of angina is this?
Unstable angina
79
Unstable angina requires what?
Medical intervention
80
Gerontologic considerations for angina
Diminished pain transition Teach them to recognize their "chest pain-like" symptoms such as weakness Pharmacologic stress testing; cardiac cath Medications and cautions
81
How do we treat angina?
Medications O2 Reduce and control risk factors Reperfusion therapy if appropriate
82
What does treatment of angina seek to do?
Decrease myocardial oxygen demand and increase oxygen supply
83
Meds that can be used for angina
Nitroglycerin Beta blockers Calcium channel blockers Antiplatelet and anticoagulants Aspirin Clopidogrel and ticlopidine Heparin Glycoprotein IIb/IIIa
84
The nurse is caring for a pt who has severe chest pain after working outside on a hot day and is brought to the ED. The nurse administers nitroglycerin to help alleviate chest pain. Which side effect should concern the nurse the most? a. Dry mucous membranes b. HR of 88 bpm c. BP of 86/58 mm Hg d. Complaint of headache
C - BP of 86/58
85
Emergency situation characterized by an acute onset of myocardial ischemia that results in myocardial death
MI
86
What does STEMI stand for?
ST elevated MI
87
What does NSTEMI stand for?
non-ST elevated MI
88
What information do you want from a patient suffering from angina?
Symptoms and activities, especially preceding attacks Risk factors, lifestyles, health promotion activities, medications, allergies Pt and family knowledge Adherence to care plan
89
What other cardiac problems may a patient with angina experience?
ACS or MI or both Arrhythmias Cardiac arrest HF Cardiogenic shock
90
What outcome goals are there for patients with angina?
Immediate and appropriate treatment Prevention of angina Reduction of anxiety Aware of disease process Understanding and adherence to care plan Absence of complications
91
Interventions for angina
Decide priority treatment Stop all activities and rest in semi-Fowlers Administer oxygen 2L/min by nasal cannula Assess pt - ECG, VS, resp distress, pain Admin medications Reassess pain and BP
92
What does a MAP of <60 mean?
Decreased perfusion
93
Interventions to reduce anxiety during angina
Calm manner Stress reduction Education Address spiritual needs any other pt or family needs
94
Interventions for preventing angina pain
Identify level of activity that causes symptoms Plan activities accordingly Alternate activities with rest periods Education
95
What education should the nurse provide their patient with angina?
Balance activity with rest Follow prescribed exercise regimen Avoid exercise in extreme temps Emotional support resources Avoid OTC meds that increase HR or BP before asking doctor Stop smoking Diet in low fat and high fiber Carry NTG everywhere - how to take Recognizing symptoms and when to call 911 BP and glucose control
96
Symptoms of acute coronary syndrome
Sudden chest pain despite rest and meds SOB Indigestion Nausea Anxiety Cool, pale skin Increased HR and BP ECG changes
97
What ECG changes can be seen with an ACS?
Elevation in the ST segment in two contiguous leads
98
Other health problems often seen with ACS
Acute pulmonary edema HF Cardiogenic shock Arrhythmias and cardiac arrest Pericardial effusion and cardiac tamponade
99
Outcome goals for a patient with ACS
Relief of pain or ischemia Prevent of myocardial damage Maintenance of effective perfusion Reduce anxiety Adherence to care plans Early recognition of symptoms
100
How quickly does the patient need to be at the cath lab after an MI?
90 min
101
Interventions for ACS
O2 and meds Frequent VS assessment Rest in bed in semi-Fowlers Pain relief to decrease workload on heart Monitor I & O and perfusion Frequent position changes to prevent resp complications Report changes in condition Evaluate interventions
102
The nurse is caring for a pt after cardiac surgery. Which nursing intervention is appropriate to help prevent complications arising from venous stasis? a. encourage crossing of legs b. use pillows in the popliteal space to elevate the knees in bed c. discourage exercising d. apply sequential pneumatic compression devices
D. compression devices
103
4 invasive coronary artery procedures
Percutaneous transluminal coronary angioplasty (PTCA) Coronary artery stent Coronary artery bypass graft (CABG) Cardiac surgery
104
What veins are commonly used for bypass graft procedures?
Iliofemoral, great and small saphenous, and intact communicating veins

Nursing 105 (11 decks)

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